Fractures

Bones are the hardest tissues in your body. Although bones are strong, they can split or break under too much pressure or force. A broken bone is called a fracture. Fractures can occur in a variety of ways. The most common causes of fractures are injuries, prolonged stress from overuse, and bone weakening diseases, such as Osteoporosis or tumors.

There are many types of fractures. They can range from a hairline crack to a bone that has broken into several pieces. Simple fractures may only require casting or splinting treatments. More complex fractures may need surgical intervention to align the bones for proper healing.

As an adult, you have over 200 bones in your body. Your bones vary in size and shape. For instance, your arms and legs contain long bones. A series of small bones, called vertebrae, make up your spine. Very small bones form your hands and feet. Some of your bones have curves, including your ribs and skull. All of your bones line up and connect to form your skeleton. In addition to creating your body structure, your bones produce blood cells, form joints with muscles for movement, and protect your internal organs.

Your bones are live tissues. They change and grow like the other parts of your body. Most of the bones in your body are composed of the same layered materials.

The outer layer of a bone is called the periosteum. It is considered the life support system for the bone because it provides the nutrient blood for bone cells. The periosteum also produces bone-developing cells during growth or after a fracture. Underneath the periosteum is compact bone, known as the cortex. Compact bone is solid and hard. It covers the cancellous “spongy” bone. The cancellous bone looks like a sponge because it contains many pores. It can resist the stresses of weight, postural changes, and growth. In many bones, the cancellous bone contains or protects the red marrow or bone marrow. Red marrow contains developing and mature blood cells.

The most frequent causes of fractures are falls and motor vehicle crashes. There is a higher incidence of fractures in some sports that involve prolonged impact, high impact, balance, or high speeds. Stress fractures can result from prolonged impact or repetitive forces. For example, running or jogging can cause stress fractures in the leg, foot, ankle, or hip. High impacts can occur during contact sports, including tackles in football or punches in boxing. Skateboarding, bicycle riding, and snow skiing are sports that involve balance and speed. Fractures can occur during contact with a hard surface, for instance during a fall to the cement while skateboarding or during contact with an object, such as a tree while snow skiing.

Fractures can also be the result of physical violence. Fractures can result from a blow with a fist or kick, or from contact with a solid weapon, such as a bat.

Although the majority of fractures result from motor vehicle crashes and falls, some fractures occur because of diseases. Osteoporosis is a medical condition that causes more bone calcium to be absorbed than is replaced. Calcium is necessary for hard healthy bones. Osteoporosis causes a reduction in bone density and brittle or fragile bones that are vulnerable to fractures. Type I Osteoporosis usually affects women between the ages of 51 and 75. Type I Osteoporosis is associated with spine and wrist fractures. Type II Osteoporosis usually affects people between the ages of 70 and 85. Type II Osteoporosis is associated with hip, pelvis, arm, and leg fractures.

Bone tumors are another disease-related cause of fractures. Most bone tumors originate elsewhere in the body and metastasize or spread to the bone. Very rarely do cancerous tumors begin in the bone. Tumors can weaken bones making them susceptible to fractures.

In some cases, a snap or cracking sound may be heard when a bone fractures. You may feel sharp, deep, or intense pain along with numbness or tingling. Your skin may swell, bruise, or bleed.

The place where your fracture occurs may look odd, bent, or out of place. Sometimes a broken bone may come through the skin. You may not be able to move or put weight on your limb or joint, or you may do so with difficulty.

Your doctor can diagnose a fracture with a physical examination. Your doctor will ask you to describe your injury and your symptoms. In most cases, imaging tests are ordered to confirm the fracture.

An X-ray will be ordered to identify the type and location of your fracture. Some fractures, such as stress fractures, may not show up on an X-ray. In such cases, Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans may be used to take a more detailed look at your bones. X-rays, CT scans, and MRI scans are painless procedures.

A bone scan is useful for identifying bone abnormalities from Osteoporosis or cancer. A bone scan may be used to show fractures, tumors, infection, and bone deterioration. A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in areas where the bone is breaking down or repairing itself.

In addition to diagnosing your fracture, your doctor will classify the type of fracture that you have in order to plan treatment appropriately. Fractures are classified by a combination of general terms used to describe their features. Fractures are categorized by the characteristics of the broken bone, including the position of the fragments or broken bone and the direction of the fracture line. Common fracture characteristics and classifications are described below.

A fracture is first classified in general terms:

Complete Fracture: The bone is completely broken into separate pieces.
Incomplete or Partial Fracture: A crack that does not completely break the bone into two pieces.
Greenstick Fracture: An Incomplete Fracture with a bowed bone, it is more common in children.
Compound or Open Fracture: The bone fragments penetrate the skin.
Simple or Closed Fracture: The bone fragments do not penetrate the skin.

Fractures are further described and classified by the position of the bone fragments:

Comminuted: The bones are broken into several pieces.
Nondisplaced: The bone is broken but maintains its alignment.
Displaced: The bone is broken and the fragments are out of position.
Segmental: More than one fracture line leads to a "floating" segment.
Angulated: The fragments are out of position and at an angle to each other.
Overriding: The fragments overlap each other.
Impacted: One piece of bone is forced into a second piece of bone.

The fracture line or crack is also described and classified. This terminology is especially used to describe fractures in the long bones of the arms and legs:

Linear: The fracture line is parallel with the shaft (the long part) of the bone.
Transverse: The fracture line is at a right (90°) angle to the shaft of the bone.
Oblique: The fracture line is at a 45° angle to the shaft of the bone.
Spiral: The fracture line has a “corkscrewed,” “curled,” or angled patter.

Surgery is recommended for fractures that do not heal properly or when the bones have broken in such a way that they are unlikely to remain aligned when set with a cast. There are several options for surgery. The type of surgery that you have will depend on the location and type of your fracture. You can have general anesthesia for surgery or your doctor can numb the area with a nerve block.

Surgical options include procedures called an Open Reduction and Internal Fixation or an Open Reduction and External Fixation. Open Reduction and Internal Fixation refers to techniques that use surgical hardware to stabilize a fracture beneath the skin. Your surgeon will make an incision and place your bones in the proper position for healing. Your surgeon will secure the bones together with surgical hardware, such as rods, screws, or metal plates.

Open Reduction and External Fixation refers to techniques that use surgical hardware to stabilize a fracture from the outside of the skin. Your surgeon will make an incision and place your bones in the proper position for healing. Your surgeon will secure the bones with surgical pins that are placed through the outside of the skin. The surgical pins are attached to a metal frame on the outside of the skin.

The treatment for a fracture depends on the type of fracture and the bones that are involved. The goal of treatment is to align the fractured bones to allow them to heal. A fractured bone is able to grow back together. When a bone is fractured, it produces a protective blood clot and callus at the end of the bones. The callus includes cells that go through phases leading to eventual bone formation and healing.

Your doctor will use your X-ray as a guide to “set” or position your bones. Some bones can be kept in place with a cast while they heal. The cast keeps the bones from moving. The hard surface of the cast protects the injury. Casts are made of a variety of materials. They are usually worn for about one to two months, depending on the type of fracture and the bone involved.

A fracture which does not heal or "unite" within the usual period of time for that fracture is said to have delayed union. The reason for the delay is not always known, but usually results from excess motion at the fracture during healing or a poor blood supply. When healing does occur, it has taken longer than normal.

A nonunion is a fracture that just won't heal. This is usually determined by time and x-rays, which show that there is no possibility that the fracture will heal without additional intervention.

A malunion is a fracture that has healed in a position outside acceptable parameters. This can be any combination of angulation, displacement, malrotation or length differences.

Delayed unions, nonunions and malunions generally require additional treatment. Bone stimulators may be used to enhance fracture healing. These are usually used externally, but sometimes are placed surgically at the fracture site. They use either electricity or ultrasound which have been shown to enhance bone generation.

Malunions and many nonunions require surgery to heal properly. Direct access to the fracture is necessary to straighten the bone, in the case of a malunion, or to remove soft tissues and stimulate blood flow at the site of a nonunion. Bone grafts are typically placed to further enhance healing.

Your pain will probably cease before your fracture has completely healed. Your doctor will limit your activity while your bone is healing. An immobilized joint will become stiff and be difficult to move. Because of this, physical or occupational therapy usually follows fracture treatment. Your therapists will work with you to regain movement, strength, and flexibility that may have decreased while your bone or joint was immobile. Your therapists may apply modalities, such as heat or ultrasound to improve blood flow, ease pain, and improve flexibility. Initial goals include pain relief and range of motion. This is followed by strengthening, and when necessary, balance retraining and sports or activity specific exercises. Your therapists can also recommend safety equipment that you can wear or use during sports, on the job, or with activities at home to support and protect your bones and joints.

Recovery time from a fracture is different for everyone. It depends on the type of fracture you had and the type of treatment you received. Your doctor will let you know what to expect. Generally, fractures need about 6 weeks to heal. Some fractures can take several months to heal. Most people have good outcomes with treatment and are able to return to their regular activities.

There are several things that you can do to help prevent fractures. Prevent vehicle crashes. Drive carefully. Wear a seatbelt. Make sure your vehicle is in good working order.

Prevent falls. A general physical examination can identify medical conditions that are associated with balance disorders or dizziness. Ask your doctor about a Bone Mineral Density Test to screen for Osteoporosis.

A vision exam can detect vision changes that are associated with falls. Some vision changes can be corrected with glasses. Additionally, people who wear bifocals or trifocal lenses should learn the correct way of walking with their glasses on.

It can be helpful to have an occupational therapist, a physical therapist, or a family member help you examine your home and remove obstacles that may cause you to trip. Such obstacles may include throw rugs, electrical cords, and even small pets. It may be helpful to install railings on your steps or in your shower. Wear low-heeled sturdy shoes. They may help you maintain proper foot positioning. A cane or walker may aid your balance while you stand or walk.

If you play sports, make sure that you wear the appropriate safety equipment. Wear the safety helmets, pads, and body gear designed for your sport or activity.

Keep your bones healthy. Do not smoke. Smoking can inhibit the healing process of bones. Make sure your diet contains healthy amounts of calcium and Vitamin D. Talk to your doctor about nutrition supplements that may be appropriate for you.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.